A study published in Osteoporosis International found that celiac disease is associated with major osteoporotic fracture, independent of fracture risk assessment tool (FRAX) score.
The Canadian study used data from the Manitoba BMD Registry to assess clinical data, bone mineral density (BMD) measurements, 10-year probability of major osteoporotic fracture calculated for each individual using the Canadian FRAX tool, and diagnosed celiac disease.
A total of 693 people with celiac disease were followed for a mean of 7.0 years and compared with a general cohort of 68,037 people who were followed for a mean of 7.1 years. People with celiac disease were younger and more likely to be men.
During the study, the proportion of people in each cohort who experienced one or more major osteoporotic fractures was the same: 8.4%. In the general population, there was agreement between FRAX-predicted and observed 10-year major osteoporotic fracture probability. However, in patients with celiac disease, predicted and observed fracture probabilities did not match unless celiac disease was considered as secondary osteoporosis. FRAX underestimated the celiac disease cohort’s 10-year major fracture risk (7.4% predicted vs. 10.8% observed; adjusted hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.11-1.86). Celiac disease was no longer a significant risk factor for fracture when secondary osteoporosis or BMD were included in the FRAX calculation (P>0.1).
Among patients with celiac disease, each standard deviation increase in FRAX score (calculated with and without secondary osteoporosis or BMD) was associated with higher risk of incident major osteoporotic fracture (adjusted HR, 1.66-1.80), similar to the general population (P>0.2). When celiac disease was included as secondary osteoporosis or when BMD was included in FRAX 10-year major osteoporotic fracture probability calculations (10.1% and 8.6%, respectively), it approximated the observed cumulative 10-year major osteoporotic fracture probability (10.8%; 95% CI, 7.8-13.9).
“When celiac disease is considered as a secondary osteoporosis risk factor or BMD is included in FRAX assessment, FRAX accurately predicts fracture risk,” the researchers concluded.